Adolescent use of adult emergency departments

Abstract

Introduction: Adolescents seek emergency care at paediatric or adult emergency departments (EDs). Paediatric EDs anecdotally report challenges of behaviour and substance use. Adult EDs report difficulty managing acute chronic illness presentations. The first aim was to uncover characteristics of adolescent presentations to adult/general EDs via a systematic literature review. The second aim was to describe characteristics of adolescents presenting to an adult university teaching hospital ED. The third aim was to improve understanding of adolescent presentations using a qualitative study. Methods: The systematic review followed PRISMA guidelines and includes published articles reporting on 10-19 year olds attending adult/general EDs. The quantitative retrospective study was of 14.5-17.9 year olds presenting to Westmead Adult’s Hospital ED, NSW Australia over three years. The semi-structured interview was with ED clinicians and used mixed methods. Results: Four manuscripts reported on adolescent outcomes in adult EDs and fulfilled search criteria. Injury accounted for most visits and almost a quarter were triaged non-urgent. Our quantitative study revealed low-acuity presentations and adolescents leaving without being seen was significantly higher than adults. Identified chronic illness and alcohol related presentations were few. Interview data showed communication and environmental barriers were common staff concerns alongside inadequate time, lack of referral pathways/resources and under-skilled staff. Conclusion: The limited studies on general adolescent presentations to adult EDs is an area of future study. Non-urgent visits that left without being seen can be explored in future to determine their suitability for primary care management. The qualitative study demonstrated a need for further training and up-skilling. We hope our data will influence hospital stakeholders to adjust ED approaches and increase staff skills.